NUR 146 - WEEK 11 - Venous Vascular Disorders

Question 1

Venous thromboembolism (VTE):

2 types
3 risk factors

Answer 1

DVT and PE (location is main difference)
Big clot in blood vessel

Risk factors = Virchow Triad
1. endothelial damage / “Vessel wall injury”
- surgery, trauma, irritation
2. venous stasis
- immobility, varicose, obstruction
3. altered coagulation /”hypercoagulability of blood”
- Cancer, thrombophilia, inflammation

Question 2

Deep vein thrombosis (DVT):

What is it
Clinical manifestations
Diagnostic

Answer 2

Clot in venous system

Clinical manifestations:
- Pain
- Redness
- Mild swelling

Diagnostics:
- Duplex ultrasound

Question 3

DVT:

Prevention

Answer 3

• Frequent ambulation, leg exercises
• Compression stockings, compression devices
• Low molecular weight heparin (lovenox)

Lifestyle changes:
- Weight loss
- Stop smoking
- Exercise

Question 4

DVT:

Goals of management
Medical Management

Answer 4

Goals:
- Prevent thrombus from extending or embolizing
- Prevent recurrent thromboemboli

Pharmacologic therapy:
- Warfarin
- NOAC

Endovascular procedure:
Invasive measures, if meds are contraindicated or thrombus is extensive
- Thrombectomy (breakdown and remove clot)
- Cava filters (filter in vena cava, blood clot will be caught here if it breaks off)

Question 5

New Oral Anti-Coagulant (NOAC)

Oral Direct Factor Xa Inhibir

Answer 5

-xaban = rivaroxaban, apixaban
Approved for treatment/prevention of DVT and PE

Advantages over warfarin
- less bleeding
- no required lab monitoring
- less drug and food interactions

Contraindication:
- poor renal failure

Antidote:
- Andexanet alfa

Question 6

DVT:

Nursing CAre

Answer 6

Mobility, NO massage!

Assess for signs of PE
- Changes in vitals or O2 Sat

Reduce discomfort:
- Pain meds
- Elevate leg
- Compression stockings
- Warmth

Question 7

Varicose veins:

What is it?
Cause?
results in? / Clinical manifestations

Answer 7

Abnormally dilated and tortuous leg veins with back flow of blood; caused by improper valve closure

Cause:
- Weakness of valve
- Thrombophlebitis
- Pregnancy
- Prolonged standing

Results in / clinical manifestations:
- Venous congestion
- Vein enlargement

Question 8

Varicose Veins:

Prevention

Answer 8

Avoid:
- prolonged sitting/standing
- Crossing legs
- socks with tight band

Do:
- Wear compression stockings (uniform compression)
- Weight reduction
- Exercise
- Elevate legs

Question 9

Varicose veins:

Medical management

Answer 9

Thermal ablation:
- Thermal energy to seal vein

Micro-phlebectomy:
- For superficial veins

Sclerotherapy:
- Injects irritant into vein, cause sclerosis and scarring

Question 10

Leg Ulcers:

What is it
Describe Arterial ulcers
Describe venous ulcers

Answer 10

Wound d/t inadequate exchange of oxygen and other nutrients

Causes:
Abnormal arterial or venous circulation

Arterial:
- Small
- Dry
- Circular

Venous Ulcers:
- Weepy, large drainage
- Large in size
- Aching pain
- Surrounding edema
- Prolonged healing

Question 11

Leg Ulcers:

Important things to assess

Answer 11

• Culture any drainage
• Assess nutrition status

Question 12

Leg Ulcers:

Medical Management

Answer 12

Pharmacologic:
- Antiseptics
- Antimicrobials

Cleansing and debridement
- Remove exudate and non-viable tissue
- Use wound cleansing agent
- AVOID cytotoxic agents (alcohol, hydrogen peroxide) on wound

Wound dressing
Hyperbaric oxygenation

Question 13

Leg Ulcer:

Nursing Care

Answer 13

Restore skin integrity:
- Clean wound
- Elevate leg for venous ulcers
- Avoid trauma & heat sources

Improve physical mobility:
- Initially restrict mobility to promote healing
- Later, activity level as tolerated = blood flow

Adequate nutrition:
- Protein
- Vitamins A, C, Zinc

Question 14

Lymphangitis:

What is it
Cause

Answer 14

Acute inflammation of lymphatic channels

Cause:
- Usually infection

Question 15

Lymphadenitis:

What is it

Answer 15

Enlarged, red and inflamed lymph nodes
- Often tender to touch

Cause:
- Usually infection

Question 16

Lymphedema:

What is it

Answer 16

Tissue swelling r/t obstruction of lymphatic

Primary: congenital
Secondary: a result of an acquired condition

Question 17

Lymphatic Conditions:

Management

Answer 17

Prevent edema from occurring

• Compression sleeves/stockings
• Lymphatic massage
• Diuretics

Question 18

Cellulitis:

What is it
Cause
Clinical manifestations

Answer 18

Infection of subcutanoue tissues

Cause:
- Strep/staph agents found on skin and environment

Clinical manifestations:
- Pain, redness, swelling
- Fever, chills, flu-like symptoms

Question 19

Cellulitis:

Treatment

Answer 19

Oral/IV antibiotics

Question 20

Cellulitis:

Nursing care

Answer 20

• Elevate extremity
• Warm moist heart
• Skin/foot care